GENERAL INFORMATION FORM -- AUTHORIZATION APPLICATION INSTRUCTIONS GENERAL INFORMATION

Transcription

1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF ENVIRONMENTAL PROTECTION GENERAL INFORMATION FORM -- AUTHORIZATION APPLICATION INSTRUCTIONS GENERAL INFORMATION To Obtain DEP Application Packages. To expedite the processing of the applicant s request, the Department of Environmental Protection (DEP) asks that you use the most up-to-date application package available. The most recent version of this General Information Form (GIF) package can be obtained by contacting the appropriate DEP office, or through our website noted below. This package, as well as other Departmentwide and/or Program-Specific Permit Application Form Packages are available in Microsoft Word format at this same web location. Applicants can download the appropriate form to a personal computer, complete the form electronically, and print the document for submittal to the Department. Access: Select: Permits, Licensing & Certification Select: Department-Wide Permit/Authorization Packages Select: General Information Form (GIF) General. This package is designed to assist the applicant in completing the General Information Form (GIF) and in determining which environmental permits or approvals are needed for the project. Please type or print clearly when completing the form. If information needed is more than space allows, attach additional sheets as necessary. If a question is not applicable to you or your project, write NA in the appropriate box. For example -- application is in reference to the Act 537 Program. Many GIF questions may not apply to this type of applicant; but program-specific forms for that particular program will need more information from the applicant. A full application for a particular DEP permit or other authorization will generally consist of this GIF and additional forms related to the particular permit or other authorization. Individual applications may require more detailed information, such as site drawings and more detailed applicant information. Moreover, an applicant may need to provide proof of financial responsibility (such as performance bonds, insurance policies, or both) in order to qualify for some DEP permits or authorizations. These requirements vary by program. Be sure to ask each program whether you must supply financial responsibility documents in order to obtain your permit or other authorization. Page 1 of 12

2 If multiple applications are submitted, only one GIF need be submitted with the various program-specific applications. If the applications are submitted at different times, the applicant may photocopy the most up-to-date version of the GIF or refer to the Application Processing System (APS) coordination number assigned by DEP (if known) when submitting forms. DEFINITIONS To provide the applicant with a better understanding of terminology, we are including the following definitions. efacts (Environment, Facility, Application, Compliance Tracking System). The Department of Environmental Protection s electronic application system to document and maintain client, site and facility data for purposes of authorizing regulated activities and tracking compliance. enotice. DEP has developed a comprehensive environmental compliance information reporting system to give the public access to permitting and compliance information on individual facilities by program and by geographic area. This system is available by logging on to the DEP website and selecting enotice. Client (Responsible Party). A client (also referred to as Applicant) is a person or organization that requests approval from DEP to perform a regulated activity. Client information is documented and assigned an internal DEP Client ID# for tracking purposes. Site (Place). A site is a physical location of importance to DEP. A site may include locations where a regulated facility is physically located or where a regulated activity occurs that has the potential to impact the health and safety of the citizens and/or the natural resources of the Commonwealth. A site is not solely defined by geographical location (can span several municipalities and even counties in some cases) but rather by the client/applicant s purpose of doing business. All DEP programs involvement at a physical location of importance to DEP is grouped under one entity site. This holistic view of site will promote an understanding of the interrelationships of facilities to support pollution prevention; multi-media inspections; a Department-wide view of compliance; and public understanding and access of information. Site information is documented and assigned an internal DEP Site ID# for tracking purposes. Site-to-Client Relationships. DEP will create internal records to relate (link) each site with all clients associated with the site and/or its facilities. Page 2 of 12

3 Facility. A facility (also referred to as Primary Facility (PF)) is a logical bridge between sites and sub-facilities that allows DEP to provide a framework for a facility s or an activity s regulation. Primary facility is a way to group a program s involvement at a site (what it regulates) under one heading. For example: The Coal Mining program groups all of their involvement (regulated entities) under the Primary Facility type of Coal Mining Operations. Facility information is documented and assigned an internal DEP Facility ID# for tracking purposes. Other examples of PFs are: Water Pollution Control Facility Radiation Facility Oil & Gas Location Water Resource Air Emissions Plant Encroachment Location Sub-Facility. A sub-facility (SF) is program-specific. A sub-facility is what DEP regulates. For example: A Deep Mine is a sub-facility of a Coal Mining Operation primary facility. Other examples of PFs and associated SFs are: Primary Facility (PF) Sub-Facility (SF) Water Pollution Control Facility Treatment Plant Discharge Point Radiation Facility X-ray Machine Radioactive Materials Oil & Gas Location Well Pit Water Resource Surface Water Withdrawal Groundwater Withdrawal Air Emissions Plant Incinerator Process Encroachment Location Bridge Dock Project. A project includes all the construction, installation, and/or renovation needed to achieve the applicant s goal. An applicant must obtain all required permits/approvals from DEP before beginning regulated activities or the construction or expansion of a regulated facility. Project information is documented and assigned an internal DEP application processing system number (APS ID#) for tracking purposes. Authorization. Any DEP approval. For example: permits, plans, approvals, licenses, registrations, certifications, etc. Authorization information is documented and assigned an internal DEP Auth ID# for tracking purposes. Page 3 of 12

4 Permit Coordination. Projects that need more than one permit/approval from DEP are coordinated so that the permits/approvals are normally issued simultaneously. CLIENT INFORMATION DEP Client ID#. Department-wide unique identification number assigned by DEP to the client after client information is entered into DEP s computer system. This one number identifies the client regardless of the program with which the client is working. This identification number will be identified on future correspondence from DEP as well as on client information available on our DEP website. When replying to DEP, inclusion of this number will make it easier to process your request in a timely manner. If you know your Client ID#, enter it. If you are a new client to DEP, skip to the next request for information. Client Type Code. Enter the code that represents the type of client acting as the responsible authority for the permitted activity. The list of Client Type Codes can be found on the list of Type Codes included at the end of this instruction document. Organization Name or Registered Fictitious Name. Clients other than individuals must provide the name under which they conduct the activity or business in which the permit or other authorization will be issued. Individuals should complete the Organization Name if they conduct their business or activity under a name other than their own (for example, Jones Construction Company, rather than Mary Jones ). For partnerships, be sure to list the business name of the partnership as it appears on legal partnership papers. If the applicant is an individual(s) or partnership, be sure to also provide the appropriate information on the individual name lines. Employer ID#. Also referred to as Federal Tax ID#. The EIN aids DEP in identifying the organization and prevents duplicate data entry from occurring. This information is required. Dun & Bradstreet ID#. If known, supply the applicant s Dun & Bradstreet Identification Number. This information is optional. Individual Last Name, First Name, MI, Suffix, Social Security Number. This information, with the exception of the SSN, must be provided for applicants who are individuals or partnerships. The SSN aids DEP in identifying the individual and prevents duplicate data entry, although, it is optional. This information is not accessible by the public or other government agencies. Page 4 of 12

5 Additional Individual Last Name, First Name, MI, Suffix, Social Security Number. This information, with the exception of the SSN, must be provided for additional applicants who are individuals or partnerships. The SSN aids DEP in identifying the individual and prevents duplicate data entry, although, it is optional. This information is not accessible by the public or other government agencies. Mailing Address. The mailing address of the client identified above (this should not include locational data that is not appropriate for a mail piece). In addition to the street number and name, PO Box#, RR# Box#, or Highway Contract# designations, use any appropriate designation and number to further define the mailing address of the applicant. e.g., APT (Apartment) DEPT (Department) RM (Room) BLDG (Building) FL (Floor) STE (Suite) City, State, ZIP+4, Country. Enter an appropriate city, borough, or town designation (do not enter a township designation in this area). Do not use abbreviations for the city name. Use the two-character abbreviation for the state. Include the four-digit extension to the ZIP code. If other than USA, provide country. Client Contact Information. Clients that are organizations must provide the name of a person representing the client (organization). This client contact must be an employee of the organization and must be located at the mailing address of the client and may receive correspondence on behalf of the client. Include the individual s name, title, daytime phone number, and address. The Department will use this contact information for maintaining client data. This individual should be a high-level employee such as CEO, VPs, Operations Manager, etc. or someone capable of answering informational questions regarding the organization such as EIN, fictitious name ownership, address data, related organizations, corporate changes, etc. Project contact information should be entered in the Site Contact found in the Site Information section. SITE INFORMATION DEP Site ID#. Department-wide unique identification number assigned to the site after site information is entered into DEP s computer system. This one number identifies the site regardless of the program with which the applicant is working. This identification number will be identified on future correspondence from DEP as well as on site information available on our DEP website. When replying to DEP, inclusion of this number will make it easier to process your application in a timely manner. If you know your Site ID#, enter it. If you are identifying a new site to DEP, skip to the next request for information. Site Name. The name of the site at the specific physical location. Do not use abbreviations, acronyms, etc. EPA ID#. If known, supply the EPA ID# for the site (this number is also referred to as a FINDS ID#). This is optional. Page 5 of 12

6 Estimated Number of Employees to be Present at Site. To assist with future Pollution Prevention and Compliance Assistance initiatives, please include the estimated number of employees to be present at the site once it is active. Description of Site. Provide a written description of the proposed site (e.g., water treatment plant, sewage treatment plant, toy factory, etc.). County, Municipality, State. Indicate the county(ies) and municipality(ies) in which the site is located. Check the appropriate box to identify the type of municipality entered (city, borough, township). Include the two-character abbreviation for the state. Site Location. Provide the physical address of the location where the permitted activities will occur. No PO Box Numbers will be accepted for site location information. Provide the City (or municipality), State, and the ZIP+4, if known. Detailed Written Directions to Site. When providing written directions, do not use PO Box address data. Include landmarks and approximate distances from the nearest highway. Site Contact Information. Provide the name of the person having overall responsibility for environmental matters at the site. Include the individual s name, title, firm, mailing address, daytime phone number, and address (optional). NAICS Codes. Clients applying for an authorization from DEP need to provide the appropriate North American Industry Classification System (NAICS pronounced nākes) code(s) at the Sector level (at a minimum). Enter all NAICS codes that pertain to the activity for which the application is being completed. More than one two-digit or threedigit NAICS code may be entered in the box provided. If you know your six-digit NAICS code, enter it in the optional box provided. The most up-to-date list of NAICS sector and subsector codes can be found on the NAICS website (part of the US Census Bureau) at or by contacting a DEP office identified at the end of this instructions document. Site-to-Client Relationship. Enter the relationship code that best describes how the client is related to the activity or operation at the site for which the permit or other authorization is being sought. The list of Site-to-Client Relationship Codes can be found on the list of Type Codes included at the end of this instructions document. FACILITY INFORMATION Modification of Existing Facility. If this project is to modify an existing facility, system, or activity, indicate the facility type and its DEP facility identification number. Latitude / Longitude. Latitude and longitude measures aid in providing the physical location of the facility. If known, indicate appropriate degrees, minutes, and seconds for the project. The Latitude/Longitude Point of Origin is the place or location where the reading was actually taken. Page 6 of 12

7 Additional Locational Data Information. This information is being requested in order to determine the method, accuracy and description of the latitude and longitude information that is being provided with the application. If known, please provide this information for your locational data. The list of locational data codes and descriptions can be found by referencing GIF Locational Data Codes. This document can be found on the DEP website with this GIF package or by contacting a DEP office identified at the end of this instructions document. PROJECT INFORMATION Project Name. Provide the name by which this proposed activity or project is, or will be, known (e.g., XYZ Sub-Division, ABC Plant Expansion). Project Description. Provide a detailed description of the project. If applying for a part of a larger project, broadly describe the entire project (e.g., a pipe crossing to serve the XYZ Sub-Division). Project Consultant Information. Provide the name of the consultant for this project, if applicable. Include the individual s name, title, firm, mailing address, daytime phone number, and address (optional). Time Schedules / Project Milestones. Provide the proposed schedule of project milestones, if any (e.g., Proposed Construction Start Date). Project s Land Use. The answer provided to Question 3 in the Project Information section will determine whether this project is subject to the Land Use Policy. Authorization/application types that are affected by DEP s Land Use Policy are attached to these instructions as Appendix A. For detailed instructions on how to complete this section, see the Department's Policy for Consideration of Local Comprehensive Plans and Zoning Ordinances in DEP Review of Authorizations for Facilities and Infrastructure - Document ID: If you are not sure if your authorization/application type is affected by the Land Use Policy, please contact the appropriate DEP office. LAND USE INFORMATION Applicants can choose an early opt-out option but are required to attach documentation indicating zoning approval from the municipal governing bodies where the project is being proposed. For more information, see the Department's Policy for Consideration of Local Comprehensive Plans and Zoning Ordinances in DEP Review of Authorizations for Facilities and Infrastructure - Document ID: If the applicant chooses the early-opt out option and zoning approval documentation is attached, the Land Use Information section does not need to be completed. Page 7 of 12

8 If the applicant does not choose the early opt-out option and the authorization/ application type is listed in Appendix A, the applicant must complete the Land Use Information section. For detailed instructions on how to complete this section, see the Department's Policy for Consideration of Local Comprehensive Plans and Zoning Ordinances in DEP Review of Authorizations for Facilities and Infrastructure - Document ID: COORDINATION INFORMATION Multiple authorizations are often required for residential, commercial, or industrial land development. This section is vital in determining if any other environmental permits or approvals are needed for your project. Special Note: By completing this section, you will assist DEP and County Conservation Districts in coordinating all authorizations that may be required for your project. County Conservation District approval does not automatically guarantee the issuance of other permits for your project, nor does it relieve you of the responsibility of making timely application for other necessary permits. Note that local municipal approvals may also be required before the project can be initiated. If your proposal will generate sewage, the local municipality will need to review its sewage plan and receive approval from DEP prior to your submission. In addition, please note that even though you may soon receive a General Permit authorization, other permit requirements may preclude site development or other activities until all permits are issued. What Your Yes Answers Mean. If you answer Yes to any of the questions in this section, you will probably need a specific permit or approval from DEP. Refer to the information provided at the end of these instructions that identifies specific regional, central, and district offices. Contact the appropriate DEP office to further discuss the need for an authorization. If additional applications are necessary, they will be mailed to you. If Yes to Question, Contact: 1.0 District Mining Permitting Section 1.1 to 1.3 Regional Air Quality Program 1.4 Regional Water Quality Permitting Section 1.5 Central Office Dam Safety Division 1.6 Regional Oil & Gas Program (located only in NC, SW & NW Regional Offices) 2.0 District Mining Permitting Section 2.1 to 2.3 Regional Air Quality Program 2.4 Regional Water Quality Permitting Section 2.5 Central Office Dam Safety Division 3.0 to 3.3 Regional Oil & Gas Program (located only in NC, SW & NW Regional Offices) 4.0 to 5.0 Local County Conservation District - or - Regional Soils & Waterways Section 6.0 to 8.0 Regional Water Quality Permitting Section 9.0 Regional/District Water Quality Planning Section 10.0 Regional Water Quality Operations Section 11.0 to 12.0 Central Office Dam Safety Division If Yes to Question, Contact: 13.0 Regional Air Quality Program Page 8 of 12

9 14.0 to 17.0 Regional Water Supply Mgmt Program - and - Watershed Management Program 18.0 Regional Waste Management Program 19.0 District Mining Permitting Section 20.0 to 23.0 Central Office Storage Tanks Division 24.0 Regional Radiation Protection Program (located only in SE, SC, SW Regional Offices) CERTIFICATION A legally responsible agent of the client should complete and sign the certification. APPLICANT S CHECKLIST To assure your application is complete, we are providing a convenient checklist of what may need to be attached to the application as well as who to contact for additional information. This checklist is optional and need not be returned with the completed application. TYPE CODES The following list of codes is to identify specific types of requested information. CLIENT INFORMATION. Client Type / Codes Government Non-Government Individual AUTH Authority ASSOR Association/Organization INDIV Individual CNTY County LLC Ltd Liability Company FED Federal Agency LLP Ltd Liability Partnership MUNI Municipality NPACO Non-Pennsylvania Corporation NONPG Non-PA Govt OTHER Other (Non-Govt) OTHG Other (Govt) PACOR Pennsylvania Corporation SCHDI School District PARTG Partnership-General STATE State Agency PARTL Partnership-Limited SOLEP Sole Proprietorship Note: If two individuals names are listed as the application s clients, the Client Type Code of Partnership/General should be used. SITE INFORMATION. Site-to-Client Relationship Codes Code Type Code Type OWN Owner LESOP Lessee / Operator OPR Operator CONTR Contractor for Owner or Operator OWNOP Owner/Operator AGENT Agent for Owner or Operator LESSE Lessee OTHER Other (Explain) Page 9 of 12

10 DEP OFFICES The following information is to assist the client with appropriate contact information when addressing the Department. Listed below is information for regional, central, and district mining offices and the counties they serve. REGIONAL OFFICES SE Regional Office 2 E. Main Street Norristown PA (484) SERO Counties: Bucks, Chester, Delaware, Montgomery, and Philadelphia. Oil & Gas issues should be addressed to NC Regional Office for these counties. Note: Air Quality in the City of Philadelphia is regulated by the Philadelphia Health Department, Division of Air Management Services (AMS). Information on AMS permitting requirements can be obtained by calling SC Regional Office 909 Elmerton Ave Harrisburg PA (717) SCRO Counties: Adams, Bedford, Berks, Blair, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juniata, Lancaster, Lebanon, Mifflin, Perry, and York. Oil & Gas issues should be addressed to NC Regional Office for these counties. SW Regional Office 400 Waterfront Dr Pittsburgh PA (412) SWRO Counties: Allegheny, Armstrong, Beaver, Cambria, Fayette, Greene, Indiana, Somerset, Washington, and Westmoreland. NE Regional Office Two Public Square Wilkes Barre PA (570) NERO Counties: Carbon, Lackawanna, Lehigh, Luzerne, Monroe, Northampton, Pike, Schuylkill, Susquehanna, Wayne, and Wyoming. Oil & Gas issues should be addressed to NC Regional Office for these counties. NC Regional Office 208 W Third St Ste 101 Williamsport PA (570) NCRO Counties: Bradford, Cameron, Clearfield, Centre, Clinton, Columbia, Lycoming, Montour, Northumberland, Potter, Snyder, Sullivan, Tioga, and Union. Oil & Gas issues should be addressed to NC Regional Office for these counties. NW Regional Office 230 Chestnut St Meadville PA (814) NWRO Counties: Butler, Clarion, Crawford, Elk, Erie, Forest, Jefferson, Lawrence, McKean, Mercer, Venango, and Warren. Page 10 of 12

11 CENTRAL OFFICES Dam Safety Division PO Box 8460 Harrisburg PA (717) Bureau of Point and Non-Point Source Management Operations Monitoring & Training Division PO Box 8774 Harrisburg PA (717) (activities outside PA) Appropriate Regional Office (activities in PA) Hazardous Waste Mgmt Division PO Box Harrisburg PA (717) Radiation Protection Bureau PO Box 8469 Harrisburg PA (717) Storage Tanks Division PO Box 8762 Harrisburg PA TANKS (toll free within PA) (717) (local & outside PA) Bureau of Point and Non-Point Source Management Planning & Permits Division PO Box 8774 Harrisburg PA (717) (activities outside PA) Appropriate Regional Office (activities in PA) Municipal & Residual Waste Mgmt Division PO Box Harrisburg PA (717) Certification & Licensing Section PO Box 8455 Harrisburg PA (717) (X-Ray Equipment Renewal) Certification & Licensing Section PO Box 8454 Harrisburg PA (717) (Water/Wastewater Certification) (717) (Sewage Enforcement Office Certification & Laboratory Certification) (717) (Blaster License, Storage Magazine License, Sales Permit, Explosives Purchase Permit) Page 11 of 12

12 DISTRICT MINING OFFICES Greensburg District Office Armbrust Bldg RR 2 Box 603-C Greensburg PA (724) Greensburg DO Counties: Allegheny, Armstrong, Beaver, Fayette, Greene, Washington, and Westmoreland. Pottsville District Office 5 W Laurel Blvd Pottsville PA (570) Pottsville DO Counties: Adams, Berks, Bucks, Carbon, Chester, Columbia, Dauphin, Cumberland, Delaware, Franklin, Juniata, Monroe, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Mifflin, Montgomery, Pike, Montour, Northampton, Perry, Northumberland, Philadelphia, Schuylkill, Snyder, Susquehanna, Union, Wayne, Wyoming, and York. California District Office California Tech Park 25 Technology Drive Coal Center PA (724) McMurray DO Counties: All counties where mining and subsidence occur. Cambria District Office 286 Industrial Park Rd Ebensburg PA (814) Cambria DO Counties: Bedford, Blair, Cambria, Fulton, Huntingdon, Indiana, and Somerset. Moshannon District Office 186 Enterprise Drive Philipsburg PA (814) Hawk Run DO Counties: Bradford, Cameron, Centre, Clearfield, Clinton, Potter, Lycoming, Sullivan, and Tioga. Knox District Office White Memorial Bldg PO Box 669 Knox PA (814) Knox DO Counties: Butler, Clarion, Crawford, Elk, Erie, Forest, Warren, Jefferson, Lawrence, McKean, Mercer, and Venango. Page 12 of 12